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Survey Paper | Pharmacy | United States of America | Volume 13 Issue 1, January 2024 | Popularity: 5.8 / 10

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Evolving Site of Care Trends in the U.S. Managed Care Ecosystem

Dinesh Kabaleeswaran, Julia Scanlan

Abstract: In the evolving U.S. managed care ecosystem, the payer is a key entity that employs strong levers of restrictions on patient access, among which site of care is an underutilized restriction. It is important to understand site of care trends because of the strong implications they have on patients, such as higher out-of-pockets costs, greater delays in treatment, and more barriers to receiving appropriate and often live-saving care. This research therefore explores payer site of care preferences across 64 payers, 29 oncologists and 151 physicians in an attempt to understand these trends. Based on the results discussed in this research study, and as a point of future discussion, it will be important for researchers in this space to take on additional topics such as payer denials for coverage of treatments administered at a non-preferred site of care, payer preference for in-home administration compared to infusion centers, manufacturers? role in optimizing site of care, and types of infusion provider and laboratory networks for payers. Future research on these topics will support greater transparency and accountability among different stakeholders in the U.S. healthcare industry to utilize site of care in a way that benefits patients moving into the second half of this decade.

Keywords: managed care, patient access, healthcare access, healthcare, site of care

Edition: Volume 13 Issue 1, January 2024

Pages: 1619 - 1623

DOI: https://www.doi.org/10.21275/SR24122015112

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